Dr. Hall ( 1 Hall E.J. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys. 2006; 65: 1-7 Abstract Full Text Full Text PDF PubMed Scopus (869) Google Scholar ) comes to the conclusion that proton therapy offers an advantage with respect to scattered doses relative to photons only if pencil beam scanning (PBS) is applied but not for broad-beam modulated (BBM) beams. We disagree with this conclusion. 1Neutron dose depends on beam delivery parameters. Intensity-modulated radiation therapy, protons, and the risk of second cancersInternational Journal of Radiation Oncology, Biology, PhysicsVol. 65Issue 1PreviewIntensity-modulated radiation therapy (IMRT) allows dose to be concentrated in the tumor volume while sparing normal tissues. However, the downside to IMRT is the potential to increase the number of radiation-induced second cancers. The reasons for this potential are more monitor units and, therefore, a larger total-body dose because of leakage radiation and, because IMRT involves more fields, a bigger volume of normal tissue is exposed to lower radiation doses. Intensity-modulated radiation therapy may double the incidence of solid cancers in long-term survivors. Full-Text PDF Neutron dose in scattered and scanned proton beams: In regard to Eric J. Hall (Int J Radiat Oncol Biol Phys 2006;65:1–7)International Journal of Radiation Oncology, Biology, PhysicsVol. 66Issue 5PreviewDr. Hall’s Fig. 10 (1) is incorrect by a factor ≥9 to the detriment of scattered vs. scanned protons. We wish to clarify the source of neutrons in scattering systems, to correct his Fig. 10, and to put neutron doses into perspective. Full-Text PDF In reply to Drs. Macklis Gottschalk, Paganetti, et alInternational Journal of Radiation Oncology, Biology, PhysicsVol. 66Issue 5PreviewWe are indebted to Drs. Gottschalk, Paganetti, and colleagues for their elegant clarifications of the sources of whole-body neutron exposures in modern proton therapy facilities: their collective knowledge and experience in this field are unmatched. We should, at the outset, say that our comments relate to the optimal mode of delivery of radiotherapeutic proton beams—not to the potential advantages of protons versus photons. Full-Text PDF In regards to Hall: Intensity-modulated radiation therapy, protons, and the risk of second cancers (Int J Radiat Oncol Biol Phys 2006;65:1–7)International Journal of Radiation Oncology, Biology, PhysicsVol. 66Issue 5PreviewSeveral recent articles in the medical literature have discussed the risk of secondary cancers occurring within the treatment field, as well as at nearby or distant sites that have received appreciable doses from scattered or leakage radiation (1–5). Many new high-tech beam-shaping approaches such as intensity-modulated radiation therapy/image-guided radiation therapy produce more conformal dose deposition patterns, but also may result in large volumes of nontarget tissue receiving low but non-negligible doses of unintentional scatter and exit radiation outside the treatment field. Full-Text PDF
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